Key result
Cardioembolic strokes linked to ~14% higher absolute early mortality compared to small-artery occlusions.
Why the study?
The study aimed to analyze patients' medical histories and treatments based on ischemic stroke etiology, focus on atrial fibrillation management in cardioembolic stroke, and identify prognostic factors for 28-day mortality.
What are the prognostic factors associated with 28-day mortality across different ischemic stroke subtypes?
Observational (n=1,912)
No
What are the prognostic factors associated with 28-day mortality across different ischemic stroke subtypes?
Cardioembolic strokes are associated with higher severity and 28-day mortality compared to other subtypes, highlighting the underdiagnosis and undertreatment of atrial fibrillation.
Cardioembolic etiology may refine early mortality risk stratification after ischemic stroke; leaves open whether targeted interventions alter outcomes.
OBJECTIVES: First, this registry-based study aimed to comprehensively analyze patients' medical histories and treatments based on ischemic strokes' etiology. We focused on the management of atrial fibrillation among patients diagnosed with cardioembolic stroke. Then, our objective was to identify prognostic factors associated with 28-day mortality. MATERIALS AND METHODS: All ischemic strokes occurring in adults between 2014 and 2021 in Lille, France, were categorized using the TOAST classification. Comparative analyses of patients' medical characteristics were conducted across subtypes. Survival rates within 28 days post-stroke were assessed, and factors influencing mortality were identified using a multivariate Cox model. RESULTS: 1912 ischemic strokes were recorded, due to cardioembolism (36%), large-artery atherosclerosis (9%), small-artery occlusion (9%), other determined causes (6%), or undetermined causes (39%). The median NIHSS score after cardioembolic stroke (6, IQR: 3-13) was twice that after small-artery occlusion (3, IQR: 2-5). Among patients with cardioembolic stroke, 26% were diagnosed post-admission with atrial fibrillation. For the 42% diagnosed pre-admission, only 54% had prior prescriptions for oral anticoagulants. Reperfusion therapies were administered in 21% of cases, with significant variations across subtypes. Mortality rates were higher after cardioembolic strokes (17%) than after small-artery occlusions (3%). Prognostic factors included etiology, high NIHSS score, atrial fibrillation, and previous heparin prescription. CONCLUSIONS: While atrial fibrillation was underdiagnosed and undertreated, patients with cardioembolic stroke exhibited high severity and elevated mortality rates. Etiology emerged as an independent predictor of early mortality, regardless of NIHSS score upon admission. These findings underscore the importance of targeted prevention to improve patient outcomes after ischemic stroke.
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Langanay et al. (2024) conducted an observational in Ischemic stroke (n=1,912). Cardioembolic stroke vs. Small-artery occlusion was evaluated on 28-day mortality. Cardioembolic strokes were associated with higher 28-day mortality (17%) compared to small-artery occlusions (3%), with etiology emerging as an independent predictor of early mortality.
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